¹TUD – Dresden University of Technology, Institute and Policlinic for Occupational and Social Medicine (IPAS) of the Medical Faculty, Dresden, Germany
²Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Abteilung Arbeitsmedizin, Gefahrstoffe und Gesundheitswissenschaften (AGG), Hamburg, Germany

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Introduction: Telerehabilitative services have been increasingly disseminated in recent years, further prompted by Covid-19 pandemic, raising questions about their effectiveness. Despite a growing body of evidence on lower back pain and hip/knee disorders, there is a lack of research on telerehabilitation for musculoskeletal disorders and traumatic injuries of the upper limb, which are significant work-related health issues. Hence, this review aims to summarize evidence on telerehabilitation in this patient group.

Methods: We searched MEDLINE, Embase and AMED (up until 27 November 2024) for publications of telerehabilitation in adults with elective orthopedic and traumatic injuries of the upper limb. Electronic searches were supplemented by handsearching and search for grey literature. Telerehabilitation was defined as therapeutic intervention including exercise, advice or self-efficacy promotion, delivered remotely with technological support. The primary outcomes were pain, ADL function and quality of life. Publications of RCTs or Non-RCTs were included if they were published in English or German language and were conducted in high income countries. The review protocol was registered in PROSPERO (CRD42024622465). Funding was provided by the German Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW).

Results: A total of 9,102 titles and abstracts and 111 full texts were screened by two reviewers. Ultimately, we included 27 studies representing 2,299 patients. Of these, 22 were RCTs and five had a non-randomized, controlled design. The majority of included trials examined diagnoses of the shoulder (n = 15), with rotator-cuff disorders being the primary focus (n = 8). Trials were mainly conducted in Spain and USA (both n = 7). Teleintervention incorporated exercise in 24 studies, a cognitive behavioural component or coaching in three studies, and exergaming in two. Twenty studies compared telerehabilitation to standard care. Of these, 14 trials examined pain, with 11 reporting no difference in interventions and three indicating improved results with telerehabilitation. Nineteen trials reported on ADL function. Findings predominantly suggested no difference between groups with three trials supporting superiority of telerehabilitation. One out of five studies observed increased quality of life for telerehabilitation. A subgroup of the aforementioned 20 studies compared telerehabilitation to in-person rehabilitation (n=12). The overall results here imply non-inferiority of telerehabilitation for pain, ADL function and quality of life. Seven trials incorporated telerehabilitation as home exercise adjunct to standard care. Herein, one out of five trials reported improved pain, whereas four trials found no difference between groups in ADL function.

Discussion: Our preliminary synthesis proposes non-inferiority for telerehabilitation versus in-person rehabilitation. For the benefit of telerehabilitation as adjunct to standard care evidence is lacking.

Conclusion: At PREMUS, we will report on accuracy of these findings, taking into consideration risk of bias assessment, quantitative synthesis (if possible) and GRADE-rating.